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Polypill for Cardiovascular Disease Prevention in an Underserved Population.
N Engl J Med 2019; 381(12):1114-1123NEJM

Abstract

BACKGROUND

Persons with low socioeconomic status and nonwhite persons in the United States have high rates of cardiovascular disease. The use of combination pills (also called "polypills") containing low doses of medications with proven benefits for the prevention of cardiovascular disease may be beneficial in such persons. However, few data are available regarding the use of polypill therapy in underserved communities in the United States, in which adherence to guideline-based care is generally low.

METHODS

We conducted a randomized, controlled trial involving adults without cardiovascular disease. Participants were assigned to the polypill group or the usual-care group at a federally qualified community health center in Alabama. Components of the polypill were atorvastatin (at a dose of 10 mg), amlodipine (2.5 mg), losartan (25 mg), and hydrochlorothiazide (12.5 mg). The two primary outcomes were the changes from baseline in systolic blood pressure and low-density lipoprotein (LDL) cholesterol level at 12 months.

RESULTS

The trial enrolled 303 adults, of whom 96% were black. Three quarters of the participants had an annual income below $15,000. The mean estimated 10-year cardiovascular risk was 12.7%, the baseline blood pressure was 140/83 mm Hg, and the baseline LDL cholesterol level was 113 mg per deciliter. The monthly cost of the polypill was $26. At 12 months, adherence to the polypill regimen, as assessed on the basis of pill counts, was 86%. The mean systolic blood pressure decreased by 9 mm Hg in the polypill group, as compared with 2 mm Hg in the usual-care group (difference, -7 mm Hg; 95% confidence interval [CI], -12 to -2; P = 0.003). The mean LDL cholesterol level decreased by 15 mg per deciliter in the polypill group, as compared with 4 mg per deciliter in the usual-care group (difference, -11 mg per deciliter; 95% CI, -18 to -5; P<0.001).

CONCLUSIONS

A polypill-based strategy led to greater reductions in systolic blood pressure and LDL cholesterol level than were observed with usual care in a socioeconomically vulnerable minority population. (Funded by the American Heart Association Strategically Focused Prevention Research Network and the National Institutes of Health; ClinicalTrials.gov number, NCT02278471.).

Authors+Show Affiliations

From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).From the Vanderbilt Translational and Clinical Cardiovascular Research Center (D.M., C.R., T.J.W.), the Division of Cardiovascular Medicine (D.M., C.R., H.G., W.S., T.J.W.), the Division of Epidemiology, Department of Medicine, and Vanderbilt Institute for Clinical and Translational Research (D.W., S.P., P.T., H.M., W.J.B.), Vanderbilt University Medical Center, Vanderbilt University, Nashville; and Franklin Primary Health Center, Mobile, AL (P.U., R.M., C.W.).

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31532959

Citation

Muñoz, Daniel, et al. "Polypill for Cardiovascular Disease Prevention in an Underserved Population." The New England Journal of Medicine, vol. 381, no. 12, 2019, pp. 1114-1123.
Muñoz D, Uzoije P, Reynolds C, et al. Polypill for Cardiovascular Disease Prevention in an Underserved Population. N Engl J Med. 2019;381(12):1114-1123.
Muñoz, D., Uzoije, P., Reynolds, C., Miller, R., Walkley, D., Pappalardo, S., ... Wang, T. J. (2019). Polypill for Cardiovascular Disease Prevention in an Underserved Population. The New England Journal of Medicine, 381(12), pp. 1114-1123. doi:10.1056/NEJMoa1815359.
Muñoz D, et al. Polypill for Cardiovascular Disease Prevention in an Underserved Population. N Engl J Med. 2019 09 19;381(12):1114-1123. PubMed PMID: 31532959.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Polypill for Cardiovascular Disease Prevention in an Underserved Population. AU - Muñoz,Daniel, AU - Uzoije,Prince, AU - Reynolds,Cassandra, AU - Miller,Roslynn, AU - Walkley,David, AU - Pappalardo,Susan, AU - Tousey,Phyllis, AU - Munro,Heather, AU - Gonzales,Holly, AU - Song,Wenliang, AU - White,Charles, AU - Blot,William J, AU - Wang,Thomas J, PY - 2019/9/19/entrez PY - 2019/9/19/pubmed PY - 2019/9/27/medline SP - 1114 EP - 1123 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 381 IS - 12 N2 - BACKGROUND: Persons with low socioeconomic status and nonwhite persons in the United States have high rates of cardiovascular disease. The use of combination pills (also called "polypills") containing low doses of medications with proven benefits for the prevention of cardiovascular disease may be beneficial in such persons. However, few data are available regarding the use of polypill therapy in underserved communities in the United States, in which adherence to guideline-based care is generally low. METHODS: We conducted a randomized, controlled trial involving adults without cardiovascular disease. Participants were assigned to the polypill group or the usual-care group at a federally qualified community health center in Alabama. Components of the polypill were atorvastatin (at a dose of 10 mg), amlodipine (2.5 mg), losartan (25 mg), and hydrochlorothiazide (12.5 mg). The two primary outcomes were the changes from baseline in systolic blood pressure and low-density lipoprotein (LDL) cholesterol level at 12 months. RESULTS: The trial enrolled 303 adults, of whom 96% were black. Three quarters of the participants had an annual income below $15,000. The mean estimated 10-year cardiovascular risk was 12.7%, the baseline blood pressure was 140/83 mm Hg, and the baseline LDL cholesterol level was 113 mg per deciliter. The monthly cost of the polypill was $26. At 12 months, adherence to the polypill regimen, as assessed on the basis of pill counts, was 86%. The mean systolic blood pressure decreased by 9 mm Hg in the polypill group, as compared with 2 mm Hg in the usual-care group (difference, -7 mm Hg; 95% confidence interval [CI], -12 to -2; P = 0.003). The mean LDL cholesterol level decreased by 15 mg per deciliter in the polypill group, as compared with 4 mg per deciliter in the usual-care group (difference, -11 mg per deciliter; 95% CI, -18 to -5; P<0.001). CONCLUSIONS: A polypill-based strategy led to greater reductions in systolic blood pressure and LDL cholesterol level than were observed with usual care in a socioeconomically vulnerable minority population. (Funded by the American Heart Association Strategically Focused Prevention Research Network and the National Institutes of Health; ClinicalTrials.gov number, NCT02278471.). SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/31532959/Polypill_for_Cardiovascular_Disease_Prevention_in_an_Underserved_Population L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa1815359?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -